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The surgical safety checklist in a UK tertiary referral obstetric centre - compliance at one year
Abstract Number: 192
Abstract Type: Original Research
Use of a surgical safety checklist, as pioneered by the World Health Organisation (WHO), has been shown to improve efficiency in the operating theatre as well as reducing morbidity and mortality. In the UK, the National Patient Safety Agency (NPSA) and Royal College of Obstetricians and Gynaecologists recommend that a similar checklist be performed for all theatre cases by February 2012. We introduced a modified surgical safety checklist into our obstetric unit in 2009 and demonstrated that it resulted in improved inter-professional communication without increasing patient anxiety. Unfortunately, compliance with the checklist 3 months after its introduction was found to be sub-optimal. We re-evaluated compliance after the checklist had been operational for one year.
After initial evaluation of compliance, staff were consulted to establish barriers to checklist performance and highlight areas for improvement. Further staff education was provided and humerous posters and accessible prompt cards were placed in obstetric theatres to serve as reminders. Compliance was re-assessed over a 1 month period at 1 year.
Anaesthetists, anaesthetic nurses and midwives were present during all pre and post-operative checklists in both assessment periods. An obstetrician was present at 91% of all checklists at 3 months and 93% at 1 year. Initially, it was a midwife most commonly leading the checklist but after one year, it was the anaesthetic nurse on 96% of occasions.
Our checklist compliance rates have increased since the introduction of the checklist but there is scope for improvement. It is not always possible for all staff to be present due to conflicting demands. A dedicated elective theatre team may be beneficial but this is dependent upon resource limitations. While progress has been made, we recognise that further work is required to further evaluate and optimise this process.
1. Haynes AB, Weiser TG, Berry WR et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Eng J Med 2009; 360: 491-92
2. National Patient Safety Agency. National reporting and learning system. Putting patient safety first. 2008. Available online at: http://www.npsa.nhs.uk/nrls (Accessed September 2010)
3. Kearns R, McGrady EM. The introduction of a surgical safety checklist in obstetric theatre; a review of staff attitudes. Int J Obstet Anesth 2010; 19(5): S15